Comparison of the short term effects of wrist flexor dry needling versus LI4 & TE5 acupuncture points dry needling on upper limb spasticity and function, in stroke patients: A Double-Blinded Randomized Clinical Trial

To determine the most effective and stable Dry Needling (DN) technique among LI4 & TE5 acupoints DN or wrist flexor DN, for Spasticity and function of stroke patients.

A randomized, double-blinded clinical trial with a parallel group design of 20 patients.

Stroke patients are recruited through the physiotherapy centers. Demographic data and outcome variables are recorded at first session. Blinding is performed on patients, examiners and performers. The patient is not aware of the type of treatment group. Examiner is not aware of the treatment method, the allocation and DN is performed by a blinded-researcher to the examination results.

Inclusion criteria: Age≥18 years old, First-ever stroke, Disease duration of at least six months, Wrist flexor MMAS spasticity score ≥1, Active and passive ROM of the involved wrist is at most 10% less than the non-involved side. Exclusion criteria: Diabetes, Inability to follow the therapist's instructions, Have contraindications to DN, Have participation simultaneously in another clinical trial, Have injections with BTXA in the 6 months preceding the study, Taking antispastic drug

Intervention group 1: the needle applies in two acupoints of forearm and hand, including LI4 and TE5."Intervention group 2: the DN is performed at the motor points of flexor carpi radialis and flexor carpi ulnaris muscles.The intervention used is DN, in which the acupuncture needle is inserted deeply into a point in the soft tissue without injecting any substance for one minute for each point. The needle is moved in different directions to the surface and depth of the tissue. The number of treatment sessions is three sessions during a week.

Spasticity(Modified Modified Ashworth Scale); motor function(Fugl-Meyer assessment); Active/Passive Range of motion

According to the number of patients in each group, the particular sort of treatment, either "wrist flexor dry needling" or "LI4&TE5 acupuncture points dry needling," is written on a piece of paper, and the paper is placed in Opaque sealed envelopes. The envelopes are then mixed. At the first visit session of each individual, the therapist who will not be involved in outcomes assessment will randomly select one of the envelopes. Based on the written sort of treatment specified, the therapist will do the patient's particular treatment. If any of the patients, for any reason, is omitted from the study, one envelope with the particular topic will be added again by the examiner, and they will be mixed again.

Although at first, the necessary explanation about the aims of the project and the existence of two groups are given to the patients, no explanation is given to them about the difference between the treatment methods. Besides, the patient's treatment sessions will be arranged so that the two groups' patients have no contact with each other and are not aware of the other group's treatment method. In this way, patients are blind regarding the treatment method. In addition, the allocation of participants into each of the treatment groups will be done by the therapist who performed the DN, and their clinical evaluation will be performed by another examiner who is not aware of the treatment group. So the examiner also is blind to the specific treatment method of each participant.

The raw data of research and its analysis will be available to researchers if they request it.

After the publication of articles resulting from the research.

Researchers working in academic institutions.

The data are available only to other researchers to study and evaluate treatment outcomes.

By sending an email to the corresponding author.

Sending an Email to the corresponding author and request the data.